title: Brain activation during speech perception in a patient with a massive left hemisphere infarction.
abstract: BACKGROUND
  Little is known about the regions involved in recovery from global aphasia in patients with malignant infarction after decompressive hemicraniectomy. This study reports a case of brain activation during speech perception in a right-handed patient with a massive left hemispheric infarction.
  
  
  METHODS
  Decompressive hemicraniectomy was performed in a 20-year old woman with space-occupying infarction of the speech dominant hemisphere. Complete anterior, middle and part of the posterior cerebral artery territories of the left hemisphere, as well as posterior regions of the right middle cerebral artery territory, were affected. Neuropsychological testing and functional magnetic resonance imaging (fMRI) during speech perception were performed 10 months after stroke.
  
  
  RESULTS
  The patient was able to walk, go up and down stairs independently and perform simple tasks at home. She was also well able to match visually and orally presented words with their corresponding pictures, despite large bilateral lesions in the posterior regions. fMRI revealed strong activation of the left temporo-occipital and parieto-occipital areas. In the right hemisphere was observed a small area of activation in the posterior part of the superior and middle temporal gyrus.
  
  
  CONCLUSIONS
  In aphasic patients, the activation of posterior bilateral associative areas might be used to support language perception.
authors.affiliation: Department of Neurosurgery and.
authors.forename: Juan
authors.initials: J
authors.lastname: Sahuquillo
authors.forename: Andreea
authors.initials: A
authors.lastname: Rădoi
authors.forename: Bessy
authors.initials: B
authors.lastname: Benejam
authors.forename: Carme
authors.initials: C
authors.lastname: Junqué
authors.forename: Davinia
authors.initials: D
authors.lastname: Fernández-Espejo
authors.forename: Maria A
authors.initials: MA
authors.lastname: Poca
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001037:Aphasia / Q000209:etiology / Q000503:physiopathology*; D002544:Cerebral Infarction / Q000150:complications / Q000503:physiopathology*; D056424:Decompressive Craniectomy; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D009483:Neuropsychological Tests; D020127:Recovery of Function; D013067:Speech Perception; D016896:Treatment Outcome